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MAC
Apr 17, 2000

What are the latest treatments for MAC? We have a patient who has MAC and wasting. We just want to make sure that there are no new treatments we are unaware of.

Response from Dr. Cohen

There have not been major changes since about 1998. As you know, clarithromycin based regimens are optimal but using more than 500 mg bid is associated with increased mortality. Rifabutin and ethambutol remain the most effective additional drugs; cipro is an alternative. Several trials have tried to look at two vs three drugs, but the results, to my mind, are inconclusive. One clear issue is that clofazamine seems to add little or nothing to mac therapy.

Of course, the big news is immune reconstitution. If you can suppress viremia and get the CD4 count over 200 some patients will be cured. In general, after a prolonged course you could consider stopping anti MAC therapy if the CD4's remain over 200. However, several relapses were recently reported in patients who maintained good CD4 numbers.



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